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Peng Z, Deng Y, Sheng X, Liu H, Li Y, Hong Y, Pan X, Meng Y. Does Screw Number of Zero-profile Implants in Fusion Segment Influence Intervertebral Stability? Orthop Surg 2024. [PMID: 38898377 DOI: 10.1111/os.14139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
OBJECTIVE The unclear clinical outcomes of two different zero-profile implants with different number of screws in hybrid surgery restricts the choice of patient-specific implants. This study aims to compare two different implants on its postoperative subsidence, motion stabilization and clinical outcomes. It also provides references to the most reasonable implant choice in fusion surgery. METHODS This was a retrospective study. From February 2014 to March 2022, 173 patients who underwent hybrid surgery were included. Among them, 122 received surgery with a four screw implant, while 51 received a two screw implant. We analyzed the significance of patient-specific factors, radiographic factors and clinical outcomes. The Wilcoxon rank sum test, t tests/analysis of variance (ANOVA) test and stepwise multivariate logistic regression were adopted for statistical analysis. RESULTS No statistically significant difference was observed between the two screw and four screw groups in terms of immediate, middle, and long-term stability and fusion rate (p > 0.05). However, the two screws group had higher FSU height subsidence at 3, 6, and 12 months postoperatively and higher rates of significant subsidence at three and 6 months postoperatively (p < 0.05). Both groups showed significant clinical improvements at the final follow-up. CONCLUSION Two screw and four screw implants provide comparable stability, fusion rates and clinical outcomes. However, the two screw implant was inferior to the four screw implant in subsidence prevention. Therefore, the two-screw implant is non-inferior to the four-screw implant in most patients. It can be used as the priority choice in the fusion segment by its easy manageability. However, the patients with a high risk of subsidence such as multilevel surgery, the elderly, lower BMD, bad cervical alignment should receive a four screw implant rather than a two screw implant.
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Affiliation(s)
- Zihan Peng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yuxiao Deng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xiaqing Sheng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Ye Li
- Department of Orthopedics, West China Hospital, Sichuan University/West China School of Nursing, Sichuan University
| | - Ying Hong
- Department of Operating Room, West China Hospital Sichuan University, Chengdu, China
- West China School of Nursing, Sichuan University, Chengdu, China
| | - Xiaoli Pan
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Meng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Yue X, Yu X, Wang F, Zhao D, Ma Y, Zhao H. Spinal cord injury without radiographic abnormality with diffuse idiopathic skeletal hyperostosis: A case report. Int J Surg Case Rep 2024; 119:109654. [PMID: 38678990 PMCID: PMC11063900 DOI: 10.1016/j.ijscr.2024.109654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/09/2024] [Accepted: 04/19/2024] [Indexed: 05/01/2024] Open
Abstract
INTRODUCTION Spinal cord injury without fracture dislocation (SCIWORA) is relatively rare, and spastic paralysis for more than 2 months with Diffuse diopathic skeletal hyperoseosis (DISH) is even rarer. CASE PRESENTATION A 70-year-old male patient presented with quadriplegia for more than 2 months after a fall. He's incontinent of stool and urine. An MRI was performed and the diagnosis was "SCIWORA, DISH". After surgical treatment, there was a significant recovery of postoperative related symptoms. CLINICAL DISCUSSION The timing of SCIWORA surgery remains controversial, with most studies suggesting that early surgery (within 24 h) is more effective. Anterior cervical discectomy and fusion (ACDF) is one of the main surgical procedures that directly and completely removes compression from the anterior aspect of the spinal cord. Patients with SCIWORA combined with DISH may have fractures due to low-energy injuries and should be treated aggressively with surgery to avoid secondary injury to the spinal cord. CONCLUSION Adult SCIWORA patients should be aggressively treated surgically when vital signs are stable and relatively calm. To avoid secondary injury, titanium plates combined with self-stabilizing fusions provide reliable immediate stabilization and can be used as one of the internal fixation modalities.
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Affiliation(s)
- Xinliang Yue
- Dongzhimen Hospital Afliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Xing Yu
- Dongzhimen Hospital Afliated to Beijing University of Chinese Medicine, Beijing 100700, China.
| | - Fengxian Wang
- Dongzhimen Hospital Afliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Dingyan Zhao
- Dongzhimen Hospital Afliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - Yukun Ma
- Dongzhimen Hospital Afliated to Beijing University of Chinese Medicine, Beijing 100700, China
| | - He Zhao
- Dongzhimen Hospital Afliated to Beijing University of Chinese Medicine, Beijing 100700, China
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Murphy TP, Tran JD, Colantonio DF, Le AH, Fredericks DR, Roach WB, Chung J, Pisano AJ, Wagner SC, Helgeson MD. Biomechanical Comparison of Anterior Cervical Plate Fixation Versus Integrated Fixation Cage for Anterior Cervical Discectomy and Fusion. Clin Spine Surg 2024:01933606-990000000-00307. [PMID: 38650076 DOI: 10.1097/bsd.0000000000001630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 03/07/2024] [Indexed: 04/25/2024]
Abstract
STUDY DESIGN Cadaveric, biomechanic study. OBJECTIVE To compare the range of motion profiles of the cervical spine following one-level anterior cervical discectomy and fusion (ACDF) constructs instrumented with either an interbody cage and anterior plate or integrated fixation cage in a cadaveric model. SUMMARY OF BACKGROUND DATA While anterior plates with interbody cages are the most common construct of fixation in ACDF, newer integrated cage-plate devices seek to provide similar stability with a decreased implant profile. However, differences in postoperative cervical range of motion between the 2 constructs remain unclear. METHODS Six cadaveric spines were segmented into 2 functional spine units (FSUs): C2-C5 and C6-T2. Each FSU was nondestructively bent in flexion-extension (FE), right-left lateral bending (LB), and right-left axial rotation (AR) at a rate of 0.5°/s under a constant axial load until a limit of 2-Nm was reached to evaluate baseline range of motion (ROM). Matched pairs were then randomly assigned to undergo instrumentation with either the standard anterior cage and plate (CP) or the integrated fixation cage (IF). Following instrumentation, ROM was then remeasured as previously described. RESULTS For CP fixation, ROM increased by 61.2±31.7% for FE, 36.3±20.4% for LB, and 31.7±19.1% for AR. For IF fixation, ROM increased by 64.2±15.5% for FE, 56.7±39.8% for LB, and 94.5±65.1% for AR. There was no significant difference in motion between each group across FE, LB, and AR. CONCLUSION This biomechanical study demonstrated increased motion in both the CP and IF groups relative to the intact, un-instrumented state. However, our model showed no differences in ROM between CP and IF constructs in any direction of motion. These results suggest that either method of instrumentation is a suitable option for ACDF with respect to constructing stiffness at time zero.
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Affiliation(s)
- Timothy P Murphy
- Department of Orthopaedics, Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Jeremy D Tran
- Department of Orthopaedics, Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Donald F Colantonio
- Department of Orthopaedics, Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Anthony H Le
- DoD-VA Extremity Trauma and Amputation Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD
| | - Donald R Fredericks
- Department of Orthopaedics, Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - William B Roach
- Department of Orthopaedics, Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Joon Chung
- Georgetown University School of Medicine, Washington, DC
| | - Alfred J Pisano
- Department of Orthopaedics, Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Scott C Wagner
- Department of Orthopaedics, Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University of the Health Sciences
| | - Melvin D Helgeson
- Department of Orthopaedics, Walter Reed National Military Medical Center
- Department of Surgery, Uniformed Services University of the Health Sciences
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Chen H, Sun H, Cao L, Xia H, Tu Q. Biomechanical evaluation of the novel assembled internal fixed system in C2-C3 anterior cervical discectomy and fusion: a finite element analysis. J Orthop Surg Res 2024; 19:106. [PMID: 38303025 PMCID: PMC10832244 DOI: 10.1186/s13018-024-04567-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND To analyze and compare the biomechanical characteristics of the new combined cervical fusion device (NCCFD) and the traditional cage-plate construct (CPC) to ascertain its effectiveness in anterior cervical discectomy and fusion (ACDF) using finite element analysis. METHODS A finite element model of the cervical spine, inclusive of the occipital bone was created and validated. In the ACDF model, either CPC or NCCFD was implanted at the C2-C3 segment of the model. A pure moment of 1.0 Nm combined with a follower load of 50 N was directed onto the superior surfaces of the occipital bone to determine flexion, extension, lateral bending (left and right), and axial rotation (left and right). The range of motion (ROM), stress distribution at the bone-implant interface, and facet joint forces were investigated and compared between CPC and NCCFD systems. RESULT The results showed that the ROMs of the fused levels in both models were nearly zero, and the motions of the unfused segments were similar. In addition, the maximum displacement exhibited nearly identical values for both models. The maximum stress of NCCFD screws in lateral bending and rotational conditions is significantly higher than that of the CPC, while the NCCFD model's maximum stress remains within an acceptable range. Comparing the maximum fusion stress, it was found that the CPC experiences much lower fusion stress in anterior flexion and extension than the NCCFD, with no significant difference between the two in lateral bending and rotational states. Stress on the cage was mainly concentrated on both sides of the wings. Comparing the maximum IDP in the CPC and NCCFD, it was observed that maximum stresses rise in extension and lateral bending for both models. Lastly, stress distributions of the facet joints were generally similar across the two devices. CONCLUSION NCCFD not only provides the same level of biomechanical stability as CPC but also avoids postoperative complications associated with uneven force damage to the implant. The device offers a novel surgical alternative for ACDF in C2-C3 level.
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Affiliation(s)
- Hu Chen
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China
- Department of Orthopedic, People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, 510010, Guangdong, China
| | - Hao Sun
- Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, China
| | - Lu Cao
- Department of Dermatology, People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, Guangdong, China
| | - Hong Xia
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China.
- Department of Orthopedic, People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, 510010, Guangdong, China.
| | - Qiang Tu
- The First School of Clinical Medicine, Southern Medical University, Guangzhou, 510515, Guangdong, China.
- Department of Orthopedic, People's Liberation Army General Hospital of Southern Theatre Command, Guangzhou, 510010, Guangdong, China.
- Guangzhou University of Chinese Medicine, Guangzhou, 510006, Guangdong, China.
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Patel AH, Ofa SA, Collins LK, McCluskey LC, Sherman WF, Cyriac M. Trends of single-level anterior cervical discectomy and fusion documentation after the 2015 Centers for Medicare & Medicaid Services coding audit. J Neurosurg Spine 2022; 37:802-811. [PMID: 35932261 DOI: 10.3171/2022.5.spine22415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 05/27/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE With the use of anterior cervical discectomy and fusion (ACDF) expected to rise by 13.3% from 2020 to 2040, the increased usage of interbody cages with integral anterior fixation prompted a Centers for Medicare & Medicaid Services (CMS) review, which resulted in coding changes affecting anterior instrumentation documentation. CMS determined that Current Procedural Terminology (CPT) code 22845 should not be used to report integrated instrumentation (plate) with an interbody device, and if additional anterior instrumentation (e.g., plates and screws) is placed with an integrated interbody device, then a 59 modifier should be used. There is sparse literature examining the trends of ACDF without and with additional anterior instrumentation after the 2015 CMS audit. Therefore, this study aimed to evaluate the trends of single-level subaxial ACDF utilization from 2011 to 2019 to determine whether the 2015 CMS audit influenced the documented usage of additional anterior instrumentation. METHODS A retrospective cohort study was performed using the commercially available database PearlDiver. Patient records were queried from 2011 to 2019 for single-level subaxial ACDF without (CPT code 22551) and with (CPT codes 22551 + 22845) instrumentation. Cochran-Armitage trend analyses were performed to evaluate the hypothesis that ACDF with additional anterior instrumentation decreased over the given time period. RESULTS Between 2011 and 2019, the total number of single-level ACDFs decreased from 6202 to 4402. From 2011 to 2015, an average of 6240 patients per year underwent single-level subaxial ACDF; of those, 950 patients (15.2%) had ACDF without instrumentation and 5290 patients (84.8%) had ACDF with instrumentation. In 2016, the total number of single-level subaxial ACDFs decreased to 5525, with 1006 patients (18.2%) receiving no instrumentation and 4519 patients (81.8%) receiving instrumentation. From 2017 to 2019, an average of 4283 patients per year underwent a single-level subaxial ACDF; of these, 1280 (29.9%) had no instrumentation and 3003 (70.1%) had instrumentation (all p < 0.0001). CONCLUSIONS From 2015 to 2019, single-level ACDF without instrumentation significantly increased by 91.5% and ACDF with anterior instrumentation significantly decreased by 18.1%. The 2015 CMS audit of interbody cages and anterior instrumentation coding (CPT code 22845) may account for the decreased documentation of anterior instrumentation in the 9-year period. Understanding CMS auditing could help surgeons perceive changes in practice patterns that may lead to a more thorough evaluation of patient outcomes, cost, and overall value.
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Affiliation(s)
- Akshar H Patel
- 1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana; and
| | - Sione A Ofa
- 1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana; and
| | - Lacee K Collins
- 2Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Leland C McCluskey
- 1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana; and
| | - William F Sherman
- 1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana; and
| | - Mathew Cyriac
- 1Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, Louisiana; and
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Wang C, Du X, Song H, Tang X, Tan J, Song Q, Cao H, Zhang Y, Xiong W. Anterior cervical plating combined with zero-profile anchored spacer for the treatment of cervical facet dislocation in elderly patients. Injury 2022; 53:3748-3753. [PMID: 36041920 DOI: 10.1016/j.injury.2022.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 08/09/2022] [Accepted: 08/15/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of this study was to evaluate the efficacy of anterior cervical plating combined with zero-profile (Z-P) anchored spacer for the treatment of cervical facet dislocation in elderly patients. METHODS This is a retrospective study. Twelve elderly patients (from 57 to 77 years old, averaged 65 years) with unilateral or bilateral facet dislocation of sub-axial cervical spine from September 2015 to September 2019 surgically treated at the authors' hospital were enrolled in this study. The patients with osteoporosis or osteopenia were all surgically treated by anterior-only procedure using cervical plating combined with zero-profile anchored spacer after closed manual reduction under general anesthesia and spinal cord monitoring. The operation times (OT), estimated blood loss (EBL), perioperative complications, were recorded. The clinical evaluation included visual analogue scales (VAS) and the American Spinal Injury Association (ASIA) scale. The radiographic evaluation included kyphotic angle (KA) and disc height (DH) and the fusion rate. RESULTS Anterior discectomy, interbody fusion and fixation were performed in all patients after the disloctions were reduced by manual maneuver. The average OT was 66 minutes, with a range from 45 to 110 minutes. The EBL averaged 42 ml per surgical procedure, with a range from 20 to 60 ml. The VAS, ASIA, KA were improved significantly after surgery (P<0.05). The average follow-up time was 24.2 months, with a range from 12 to 38 months. There were no statistical differences between the immediately post-op KA and KA at the last follow-up (P>0.05). No disc space subsidence was observed statistically (P<0.05) Interbody fusion was obtained in all patients. Two patient experienced slight difficulty in swallowing, which were improved 6 weeks later. There were no hardware failure, no segmental instability, no wound infection or other complications. CONCLUSIONS Manual reduction with spinal cord monitoring under general anesthesia is a safe and efficient option and the anterior cervical plating combined with Z-P spacer could achieve reliable fixation for the patients with cervical facet dislocation in the elderly patients with osteoporosis or osteopenia.
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Affiliation(s)
- Chunxiao Wang
- Department of Spine Surgery, Yantai Affiliated Hospital of Binzhou Medical University, No. 717, Jinbu Street, Muping District, Yantai, Shandong 264000, China
| | - Xiaowen Du
- Department of Spine Surgery, Yantai Affiliated Hospital of Binzhou Medical University, No. 717, Jinbu Street, Muping District, Yantai, Shandong 264000, China
| | - Hongkai Song
- Department of Spine Surgery, Yantai Affiliated Hospital of Binzhou Medical University, No. 717, Jinbu Street, Muping District, Yantai, Shandong 264000, China
| | - Xiaojie Tang
- Department of Spine Surgery, Yantai Affiliated Hospital of Binzhou Medical University, No. 717, Jinbu Street, Muping District, Yantai, Shandong 264000, China
| | - Jiangwei Tan
- Department of Spine Surgery, Yantai Affiliated Hospital of Binzhou Medical University, No. 717, Jinbu Street, Muping District, Yantai, Shandong 264000, China.
| | - Qinyong Song
- Department of Spine Surgery, Yantai Affiliated Hospital of Binzhou Medical University, No. 717, Jinbu Street, Muping District, Yantai, Shandong 264000, China
| | - Haifei Cao
- Department of Spine Surgery, Yantai Affiliated Hospital of Binzhou Medical University, No. 717, Jinbu Street, Muping District, Yantai, Shandong 264000, China
| | - Yao Zhang
- Department of Spine Surgery, Yantai Affiliated Hospital of Binzhou Medical University, No. 717, Jinbu Street, Muping District, Yantai, Shandong 264000, China
| | - Wei Xiong
- Department of Spine Surgery, Yantai Affiliated Hospital of Binzhou Medical University, No. 717, Jinbu Street, Muping District, Yantai, Shandong 264000, China
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Chen X, Sial A, Stewart C, Vargas Castillo J, Diwan AD. Stand-alone anterior cervical decompression and fusion surgery: A cohort study evaluating a shaped cage without plates or screws. Front Surg 2022; 9:934018. [PMID: 36211269 PMCID: PMC9532519 DOI: 10.3389/fsurg.2022.934018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Background The anterior approach to the cervical spine is the most commonly used surgery with effective decompression and less surgical trauma. Anterior plate construct (APC) is considered a standard technique. However, it appears to cause implant failure and postoperative dysphagia. Due to these reasons, locking stand-alone cages (LSCs) without the addition of an anterior plate have been developed and gained popularity in the past decade. In theory, an LSC could provide immediate load-bearing support to the anterior column of the cervical spine and may enhance the rate of arthrodesis. However, screw skiving and backing off are known complications of LSC. Given the characteristic shape of cervical discs, we wondered whether there may be a role for a shape-conforming cage without screws and plates to achieve desired outcomes, i.e., a true stand-alone cage (TSC). A single surgeon cohort using the cage in a heterogenic set of indications was evaluated. Methods A total of 45 patients with degenerative cervical conditions who underwent surgery using TSC using CoRoent Small Contoured peek cage (Nuvasive, San Diego, CA) and Orthoblend™ (Medtronics, Memphis, TN) were retrospectively reviewed. Comparisons between preoperative and postoperative Numeric Rating Scale (NRS), the modified AAOS-Modems disability outcome, Neck Disability Index (NDI) scores, and Short Form 36 were evaluated. Operative time, the occurrence rate of fusion, lordosis change of cervical spine, and occurrence rate of complications were evaluated. Results There were one-level (n = 15), two-level (n = 24), and three-level (n = 6) cases making a total of 81 cages implanted and studied. The mean operative time was 132.7 min. The group demonstrated significant improvements in NRS, AAOS-Modems disability outcome, and NDI scores after surgery (mean follow-up 12 months). The cervical lordosis at pre- and last follow-up period was 8.7 ± 2.2° and 8.3 ± 3.2°, respectively. The complication rate was 21.2%. Conclusions TSC yielded satisfactory long-term clinical and radiological outcomes; this preliminary report can form the basis of a cost–benefit analysis study either prospectively or by way of meta-modeling comparing APC, LSC to TSC.
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Affiliation(s)
- Xiaolong Chen
- Spine Labs, St. George / Sutherland Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Alisha Sial
- Spine Service, Department of Orthopaedic Surgery, St. George Hospital Campus, Kogarah, NSW, Australia
| | - Charmian Stewart
- Spine Labs, St. George / Sutherland Clinical School, University of New South Wales, Kogarah, NSW, Australia
| | - Jose Vargas Castillo
- Spine Service, Department of Orthopaedic Surgery, St. George Hospital Campus, Kogarah, NSW, Australia
| | - Ashish D. Diwan
- Spine Labs, St. George / Sutherland Clinical School, University of New South Wales, Kogarah, NSW, Australia
- Spine Service, Department of Orthopaedic Surgery, St. George Hospital Campus, Kogarah, NSW, Australia
- Correspondence: Ashish D. Diwan
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Jin LY, Wei K, Feng DM, Li JD, Song XX, Yin HL, Li XF. Changes of adjacent segment biomechanics after anterior cervical interbody fusion with different profile design plate: single- versus double-level. Comput Methods Biomech Biomed Engin 2022; 26:744-753. [PMID: 35695468 DOI: 10.1080/10255842.2022.2086800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Low-profile angle-stable spacer Zero-P is claimed to reduce the morbidity associated with traditional plate and cage construct (PCC). Both Zero-P and PCC could achieve comparable mid- and long-term clinical and radiological outcomes in anterior cervical discectomy and fusion (ACDF). It is not clear whether Zero-P can reduce the incidence of adjacent segment degeneration (ASD), especially in multi-segmental fusion. This study aimed to test the effect of fusion level with Zero-P versus with PCC on adjacent-segment biomechanics in ACDF. A three-dimensional finite element (FE) model of an intact C2-T1 segment was built and validated. Six single- or double-level instrumented conditions were modeled from this intact FE model using Zero-P or the standard PCC. The biomechanical responses of adjacent segments at the cephalad and caudal levels of the operation level were assessed in terms of range of motion (ROM), stresses in the endplate and disc, loads in the facets. When comparing the increase of adjacent-segment motion in single-level PCC fusion versus Zero-P fusion, a significantly larger increase was found in double-level fusion condition. The fold changes of PCC versus Zero-P of intradiscal and endplate stress, and facet load at adjacent levels in the double-level fusion spine were significantly larger than that in the single-level fusion spine during the sagittal, the transverse, and the frontal plane motion. The increased value of biomechanical features was greater at above segment than that at below. The fold changes of PCC versus Zero-P at adjacent segment were most notable in flexion and extension movement. Low-profile device could decrease adjacent segment biomechanical burden compared to traditional PCC in ACDF, especially in double-level surgery. Zero-P could be a good alternative for traditional PCC in ACDF. Further clinical/in vivo studies will be necessary to explore the approaches selected for this study is warranted.
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Affiliation(s)
- Lin-Yu Jin
- Department of Orthopaedic Surgery, Baoshan Branch of Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P.R. China.,Department of spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P.R. China
| | - Ke Wei
- Department of Orthopaedic Surgery, Baoshan Branch of Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P.R. China
| | - Da-Ming Feng
- Department of Orthopaedic Surgery, Baoshan Branch of Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P.R. China
| | - Jian-Dong Li
- Department of Orthopaedic Surgery, Baoshan Branch of Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P.R. China
| | - Xiao-Xing Song
- Department of Anesthesiology, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, P.R. China
| | - Hong-Ling Yin
- School of Materials Science and Engineering, Shanghai Jiaotong University, Shanghai, P.R. China
| | - Xin-Feng Li
- Department of Orthopaedic Surgery, Baoshan Branch of Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P.R. China.,Department of spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, P.R. China
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Ansaripour H, Ferguson S, Flohr M. In-vitro Biomechanics of the Cervical Spine: a Systematic Review. J Biomech Eng 2022; 144:1140519. [PMID: 35482019 DOI: 10.1115/1.4054439] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Indexed: 11/08/2022]
Abstract
In-vitro testing has been conducted to provide a comprehensive understanding of the biomechanics of the cervical spine. This has allowed a characterization of the stability of the spine as influenced by the intrinsic properties of its tissue constituents and the severity of degeneration or injury. This also enables the pre-clinical estimation of spinal implant functionality and the success of operative procedures. The purpose of this review paper was to compile methodologies and results from various studies addressing spinal kinematics in pre- and post-operative conditions so that they could be compared. The reviewed literature was evaluated to provide suggestions for a better approach for future studies, to reduce the uncertainties and facilitate comparisons among various results. The overview is presented in a way to inform various disciplines, such as experimental testing, design development, and clinical treatment. The biomechanical characteristics of the cervical spine, mainly the segmental range of motion (ROM), intradiscal pressure (IDP), and facet joint load (FJL), have been assessed by testing functional spinal units (FSUs). The relative effects of pathologies including disc degeneration, muscle dysfunction, and ligamentous transection have been studied by imposing on the specimen complex load scenarios imitating physiological conditions. The biomechanical response is strongly influenced by specimen type, test condition, and the different types of implants utilized in the different experimental groups.
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Affiliation(s)
- Hossein Ansaripour
- CeramTec GmbH, Plochingen, Germany; Institute for Biomechanics, D-HEST, ETH, Zurich, Switzerland, CeramTec GmbH, CeramTec-Platz 1-9, 73207 Plochingen, Germany
| | - Stephen Ferguson
- Institute for Biomechanics, D-HEST, ETH, Zurich, Switzerland, Hönggerbergring 64, HPP O-22, 8093 Zurich, Switzerland
| | - Markus Flohr
- CeramTec GmbH, Plochingen, Germany, CeramTec GmbH, CeramTec-Platz 1-9, 73207 Plochingen, Germany
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Buontempo MG, Imam N, Koerner J. Stand-Alone Interbody Cage to Treat Cervical Facet Dislocation: A Case Report. JBJS Case Connect 2022; 12:01709767-202203000-00011. [PMID: 35020634 DOI: 10.2106/jbjs.cc.21.00489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We present a 36-year-old man who sustained a traumatic C5-6 unilateral facet dislocation without neurological deficit. The patient was treated with anterior diskectomy and fusion using a stand-alone interbody cage. CONCLUSION Current treatment of cervical facet dislocations (CFDs) in patients undergoing an anterior cervical diskectomy and fusion commonly makes use of plates with screw fixation and interbody grafts or cages to achieve spinal fusion after the diskectomy is performed. This report documents the successful treatment of a CFD with a stand-alone interbody cage.
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Affiliation(s)
- Michael G Buontempo
- Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine, Nutley, New Jersey
| | - Nareena Imam
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Paramus, New Jersey
| | - John Koerner
- Department of Orthopaedic Surgery, Hackensack Meridian School of Medicine, Nutley, New Jersey.,Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Paramus, New Jersey
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11
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A critical review on the biomechanical study of cervical interbody fusion cage. MEDICINE IN NOVEL TECHNOLOGY AND DEVICES 2021. [DOI: 10.1016/j.medntd.2021.100070] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
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12
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Tan LA. Commentary: Vertebral Body Replacement With an Anchored Expandable Titanium Cage in the Cervical Spine: A Clinical and Radiological Evaluation. Oper Neurosurg (Hagerstown) 2020; 20:E35-E36. [PMID: 33027816 DOI: 10.1093/ons/opaa316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 08/02/2020] [Indexed: 11/14/2022] Open
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13
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Locking stand-alone cage versus anterior plate construct in anterior cervical discectomy and fusion: a systematic review and meta-analysis based on randomized controlled trials. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:2734-2744. [PMID: 32770359 DOI: 10.1007/s00586-020-06561-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 06/15/2020] [Accepted: 08/02/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE To evaluate the efficacy of locking stand-alone cage (LSC) compared with anterior plate construct (APC) in anterior cervical discectomy and fusion (ACDF). METHODS A comprehensive literature search was carried out in PubMed, Embase, Web of Science, and Cochrane Library to screen randomized controlled trials (RCTs) that directly compared LSC with APC in ACDF. The Cochrane Collaboration's tool was used for assessment of study quality. Data were analyzed with the Review Manager 5.3 software. RESULTS A total of seven RCTs were included. The results revealed no significant differences between LSC and APC in ACDF regarding the fusion rate, Japanese Orthopaedic Association score, visual analogue scale score, neck disability index score, hospital stay, subsidence rate, cervical lordosis, segmental Cobb angle, and disc height. However, LSC was associated with a significantly shorter operation time, less blood loss, lower overall incidence of dysphagia, and lower adjacent-level ossification (ALO) rate compared with APC. CONCLUSION In summary, LSC is not only a safe and effective device for ACDF but also has the advantages of significantly reduced operation time, blood loss, overall incidence of dysphagia, and ALO rate over APC. Therefore, LSC is a better alternative than APC for the patients undergoing ACDF procedures.
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Li XF, Jin LY, Liang CG, Yin HL, Song XX. Adjacent-level biomechanics after single-level anterior cervical interbody fusion with anchored zero-profile spacer versus cage-plate construct: a finite element study. BMC Surg 2020; 20:66. [PMID: 32252742 PMCID: PMC7137311 DOI: 10.1186/s12893-020-00729-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/25/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The development of adjacent segment degeneration (ASD) following ACDF is well established. There is no analytical study related to effects of plate profile on the biomechanics of the adjacent-level after ACDF. This study aimed to test the effects of plate profile on the adjacent-level biomechanics after single-level anterior cervical discectomy and fusion (ACDF). METHODS A three-dimensional finite element model (FEM) of an intact C2-T1 segment was built and validated. From this intact model, two instrumentation models were constructed with the anchored zero-profile spacer or the standard plate-interbody spacer after a C5-C6 corpectomy and fusion. Motion patterns, the stresses in the disc, the endplate, and the facet joint at the levels cephalad and caudal to the fusion were assessed. RESULTS Compared with the normal condition, the biomechanical responses in the adjacent levels were increased after fusion. Relative to the intact model, the average increase of range of motion (ROM) and stresses in the endplate, the disc, and the facet of the zero-profile spacer fusion model were slightly lower than that of the standard plate-interbody spacer fusion model. The kinematics ROM and stress variations above fusion segment were larger than that below. The biomechanical features of the adjacent segment after fusion were most affected during extension. CONCLUSIONS The FE analysis indicated that plate profile may have an impact on the biomechanics of the adjacent-level after a single-level ACDF. The impact may be long-term and cumulative. The current findings may help explain the decreasing incidence of ASD complications in the patients using zero-profile spacer compared with the patients using cage and plate construct.
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Affiliation(s)
- Xin-Feng Li
- Department of Orthopaedic Surgery, Baoshan Branch of Renji Hospital, School of Medicine, Shanghai Jiaotong University, No. 1058, Huan Zheng Bei Rd, Shanghai, 200444, P.R. China.
| | - Lin-Yu Jin
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, 100044, China
| | - Chao-Ge Liang
- Department of Orthopaedic Surgery, Shanghai Xijiao Orthopaedic Hospital, Shanghai, 200336, China
| | - Hong-Ling Yin
- School of Materials Science and Engineering, Shanghai Jiaotong University, No. 1954, Huashan Rd, Shanghai, 20030, P.R. China.
| | - Xiao-Xing Song
- Department of Anesthesiology, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, 197 Ruijin Er Lu, Shanghai, 200025, China.
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15
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Mu X, Li Z, Ou Y, Wei J. Early and short-segment anterior spinal fusion for cervical spinal cord injury without fracture and dislocation can achieve more significant neurological recovery: a retrospective study based on the current medical system in southern China. J Orthop Surg Res 2019; 14:414. [PMID: 31805960 PMCID: PMC6896359 DOI: 10.1186/s13018-019-1487-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 11/26/2019] [Indexed: 01/09/2023] Open
Abstract
Objective The purpose of this study was to investigate the effects of the number of fused segments, the timing of surgery and their interaction on the prognosis of patients with cervical spinal cord injury without fracture and dislocation (CSCIWFD), and to determine the appropriate time restrictions for early surgery in CSCIWFD patients based on the current diagnosis and treatment system in southern China. Methods CSCIWFD patients who underwent anterior cervical decompression and internal fusion (ACDF) from January 2012 to June 2017 were selected. The patients were grouped according to the timing of surgery and the number of fused segments and evaluated based on their American Spinal Injury Association (ASIA) score, ASIA impairment scale, and Japanese Orthopaedic Association (JOA) score before and after surgery. SPSS22.0 software was used for the statistical analysis. Results The ASIA score, JOA score, and ASIA impairment scale in all follow-ups were significantly higher than before surgery (p < 0.05). The ASIA and JOA scores at 6, 12, and 24 months after surgery of the patients who underwent ACDF within 72 h were significantly better than those of the patients who underwent ACDF after 72 h (p < 0.05). There were significant differences in postoperative ASIA and JOA scores at 12 and 24 months between the short-segment and three-segment fusion groups (p < 0.05). The results of the interaction between the surgical timing and the number of the fused segments showed that the postoperative ASIA and JOA scores at 6, 12, and 24 months were significantly higher in the patients who underwent early short-segment fusion than in those who underwent delayed short-segment fusion (p < 0.05). However, no statistically significant difference was found between early and delayed surgery in the patients who underwent three-segment fusion (p > 0.05). Conclusion ACDF is safe and effective for the treatment of CSCIWFD. For patients with single- or double-segment injury, early (within 72 h) ACDF is associated with a more satisfactory prognosis. Due to the limitation of the small sample size, we cautiously recommend that 72 h can be used as a time limit for early surgery for CSCIWFD patients in regions where earlier surgery cannot be provided by the current diagnosis and treatment system.
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Affiliation(s)
- Xiaoping Mu
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Zhuhai Li
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China
| | - Yufu Ou
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China.
| | - Jianxun Wei
- Department of Orthopaedics, The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, 530021, China.
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Panchal R, Gandhi A, Ferry C, Farmer S, Hansmann J, Wanebo J. A Biomechanical Evaluation of a Next-Generation Integrated and Modular ACDF Device Possessing Full-Plate, Half-Plate, and No-Profile Fixation Iterations. Global Spine J 2019; 9:826-833. [PMID: 31819848 PMCID: PMC6882088 DOI: 10.1177/2192568219834252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
STUDY DESIGN In vitro biomechanical study. OBJECTIVES The objective of this in vitro biomechanical range-of-motion (ROM) study was to evaluate spinal segmental stability following fixation with a novel anterior cervical discectomy and fusion (ACDF) device ("novel device") that possesses integrated and modular no-profile, half-plate, and full-plate fixation capabilities. METHODS Human cadaveric (n = 18, C3-T1) specimens were divided into 3 groups (n = 6/group). Each group would receive one novel device iteration. Specimen terminal ends were potted. Each specimen was first tested in an intact state, followed by anterior discectomy (C5/C6) and iterative instrumentation. Testing order: (1) novel device (group 1, no-profile; group 2, half-plate; group 3, full-plate); (2) novel device (all groups) with lateral mass screws (LMS); (3) traditional ACDF plate + cage; (4) traditional ACDF plate + cage + LMS. A 2 N·m moment was applied in flexion/extension (FE), lateral bending (LB), and axial rotation (AR) via a kinematic testing machine. Segmental ROM was tracked and normalized to intact conditions. Comparative statistical analyses were performed. RESULTS Key findings: (1) the novel half- and full-plate constructs provided comparable reduction in FE and LB ROM to that of traditional plated ACDF (P ≥ .05); (2) the novel full-plate construct significantly exceeded all other anterior-only constructs (P ≤ .05) in AR ROM reduction; and (3) the novel half-plate construct significantly exceeded the no-profile construct in FE (P < .05). CONCLUSIONS The novel ACDF device may be a versatile alternative to traditional no-profile and independent plating techniques, as it provides comparable ROM reduction in all principle motion directions, across all device iterations.
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Affiliation(s)
| | - Anup Gandhi
- Zimmer Biomet Spine Research & Development, Westminster, CO, USA
| | - Chris Ferry
- Cooper Medical School of Rowan University, Camden, NJ, USA,Chris Ferry, Cooper Medical School of Rowan University, 401 Broadway, Camden, NJ 08103, USA.
| | - Sam Farmer
- Zimmer Biomet Spine Research & Development, Westminster, CO, USA
| | - Jeremy Hansmann
- Zimmer Biomet Spine Research & Development, Westminster, CO, USA
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Arnold PM, Cheng I, Harris JA, Hussain MM, Zhang C, Karamian B, Bucklen BS. Single-Level In Vitro Kinematic Comparison of Novel Inline Cervical Interbody Devices With Intervertebral Screw, Anchor, or Blade. Global Spine J 2019; 9:697-707. [PMID: 31552149 PMCID: PMC6745635 DOI: 10.1177/2192568219833055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
STUDY DESIGN In vitro cadaveric biomechanical study. OBJECTIVE To compare the biomechanics of integrated anchor and blade versus traditional screw fixation techniques for interbody fusion. METHODS Fifteen cadaveric cervical spines were divided into 3 equal groups (n = 5). Each spine was tested: intact, after discectomy (simulating an injury model), interbody spacer alone (S), integrated interbody spacer (iSA), and integrated spacer with lateral mass screw and rod fixation (LMS+iS). Each treatment group included integrated spacers with either screw, anchor, or blade integrated spacers. Constructs were tested in flexion-extension (FE), lateral bending (LB), and axial rotation (AR) under pure moments (±1.5 N m). RESULTS Across all 3 planes, the following range of motion trend was observed: Injured > Intact > S > iSA > LMS+iS. In FE and LB, integrated anchor and blade significantly decreased motion compared with intact and injured conditions, before and after supplemental posterior fixation (P < .05). Comparing tested devices revealed biomechanical equivalence between screw, anchor, and blade fixation methods in all loading modes (P > .05). CONCLUSION All integrated interbody devices reduced intact and injured motion; lateral mass screws and rods further stabilized the single motion segment. Comparing screw, anchor, or bladed integrated anterior cervical discectomy and fusion spacers revealed no significant differences.
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Affiliation(s)
| | - Ivan Cheng
- Stanford University Hospital and Clinics, Redwood City, CA, USA
| | - Jonathan A. Harris
- Musculoskeletal Education and Research Center, a Division of Globus Medical,
Inc, Audubon, PA, USA
- Jonathan A. Harris, Globus Medical, Inc, 2560
General Armistead Avenue, Audubon, PA 19403, USA.
| | - Mir M. Hussain
- Musculoskeletal Education and Research Center, a Division of Globus Medical,
Inc, Audubon, PA, USA
| | | | - Brian Karamian
- Stanford University Hospital and Clinics, Redwood City, CA, USA
| | - Brandon S. Bucklen
- Musculoskeletal Education and Research Center, a Division of Globus Medical,
Inc, Audubon, PA, USA
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El Baz EA, Sultan AM, Barakat AS, Koptan W, ElMiligui Y, Shaker H. The use of anterior cervical interbody spacer with integrated fixation screws for management of cervical disc disease. SICOT J 2019; 5:8. [PMID: 30834889 PMCID: PMC6405254 DOI: 10.1051/sicotj/2019002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 01/08/2019] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Integrated cage and screw designs were introduced for anterior cervical discectomy and fusion (ACDF) and allegedly are superior to anterior plating due to their minimal anterior profile. METHODS A descriptive study was designed as a prospective case series of 25 patients (30 operated discs) with cervical disc disease treated with a zero-profile cage, and followed up for an average of 16 months (range 12 -18 months). Functional assessment was done with the Neck Disability Index (NDI) and Visual analog scale (VAS) scores for arm and neck pain. Furthermore, Nurick's classification system for myelopathy based on gait abnormalities was documented. Radiological fusion was confirmed with plain X-rays and when indicated with a CT scan at 12 months postoperatively. Dysphagia was classified according to the Bazaz criteria. RESULTS VAS for neck and arm pain, NDI, and Nurick Score immediately improved postoperatively and remained so at 12-month follow-up. Fusion was achieved in 19 patients (95%) at six months and in 20 patients (100%) of the single-level group at one year. At six months 80% (four patients) and at 12 months 100% (five patients) showed complete union in the double-level group. No evidence of cage subsidence was noted radiographically. DISCUSSION The favorable lordosis and fusion rates of the low-profile integrated device are consistent with ACDF using anterior plating. Additionally, improved pain and an acceptable rate of dysphagia support the use of integrated interbody spacers for use in ACDF procedures.
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Affiliation(s)
- Ehab Adel El Baz
- Agouza Armed Forces Spine Surgery Center, Farid Shawky Street, Giza, Egypt
| | - Ahmed Maher Sultan
- Orthopedics and Traumatology Department, Faculty of Medicine, Cairo University, Kasr Alainy Street, Cairo, Egypt
| | - Ahmed Samir Barakat
- Orthopedics and Traumatology Department, Faculty of Medicine, Cairo University, Kasr Alainy Street, Cairo, Egypt
| | - Wael Koptan
- Orthopedics and Traumatology Department, Faculty of Medicine, Cairo University, Kasr Alainy Street, Cairo, Egypt
| | - Yasser ElMiligui
- Orthopedics and Traumatology Department, Faculty of Medicine, Cairo University, Kasr Alainy Street, Cairo, Egypt
| | - Hesham Shaker
- Agouza Armed Forces Spine Surgery Center, Farid Shawky Street, Giza, Egypt
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Takhelmayum U, Acharya S, Chahal R, Kalra KL, Gupta P, Palukuri N. Integrated screws with cage spacer system in the treatment of cervical spine degenerative disease with a minimum follow-up of 2 years. JOURNAL OF ORTHOPEDICS, TRAUMATOLOGY AND REHABILITATION 2019. [DOI: 10.4103/jotr.jotr_44_15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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20
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Mojica‐Santiago JA, Lang GM, Navarro‐Ramirez R, Hussain I, Hӓrtl R, Bonassar LJ. Resorbable plating system stabilizes tissue-engineered intervertebral discs implanted ex vivo in canine cervical spines. JOR Spine 2018; 1:e1031. [PMID: 31463449 PMCID: PMC6686817 DOI: 10.1002/jsp2.1031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/18/2018] [Accepted: 07/31/2018] [Indexed: 12/29/2022] Open
Abstract
Total disc replacement using tissue-engineered intervertebral discs (TE-IVDs) may offer a biological alternative to treat radiculopathy caused by disc degeneration. A composite TE-IVD was previously developed and evaluated in rat tail and beagle cervical spine models in vivo. Although cell viability and tissue integration into host tissue were promising, significant implant displacement occurred at multiple spinal levels. The goal of the present study was to assess the effects of a resorbable plating system on the stiffness of motion segments and stability of tissue-engineered implants subjected to axial compression. Canine motion segments from levels C2/C3 to C5/C6 were assessed as intact (CTRL), after discectomy (Dx), with an implanted TE-IVD only (PLATE-), and with a TE-IVD combined with an attached resorbable plate (PLATE+). Segments under PLATE+ conditions fully restored separation between endplates and showed significantly higher compressive stiffness than segments under PLATE- conditions. Plated segments partially restored more than 25% of the CTRL motion segment stiffness. Plate attachment also prevented implant extrusion from the disc space at 50% compressive strain, and this effect was more significant in segments from levels C3/C4 when compared to segments from level C5/C6. These results suggest that stabilization of motion segments via resorbable plating assists TE-IVD retention in the disc space while allowing the opportunity for implants to fully integrate into the host tissue and achieve optimal restoration of spine biomechanics.
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Affiliation(s)
| | - Gernot M. Lang
- Weill Cornell Brain and Spine Center, Department of Neurological SurgeryWeill Cornell Medicine, New York‐Presbyterian HospitalNew YorkNew York
- Department of Orthopaedic and Trauma SurgeryMedical Center‐Albert Ludwig University of Freiburg, Faculty of MedicineFreiburgGermany
| | - Rodrigo Navarro‐Ramirez
- Weill Cornell Brain and Spine Center, Department of Neurological SurgeryWeill Cornell Medicine, New York‐Presbyterian HospitalNew YorkNew York
| | - Ibrahim Hussain
- Weill Cornell Brain and Spine Center, Department of Neurological SurgeryWeill Cornell Medicine, New York‐Presbyterian HospitalNew YorkNew York
| | - Roger Hӓrtl
- Weill Cornell Brain and Spine Center, Department of Neurological SurgeryWeill Cornell Medicine, New York‐Presbyterian HospitalNew YorkNew York
| | - Lawrence J. Bonassar
- Meinig School of Biomedical EngineeringCornell UniversityIthacaNew York
- Sibley School of Mechanical and Aerospace EngineeringCornell UniversityIthacaNew York
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Kani KK, Chew FS. Anterior cervical discectomy and fusion: review and update for radiologists. Skeletal Radiol 2018; 47:7-17. [PMID: 29058045 DOI: 10.1007/s00256-017-2798-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/06/2017] [Accepted: 10/11/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The goals of this article are to describe the various types of interbody grafts and anterior cervical plating systems, techniques for optimizing evaluation of cervical spine metallic implants on CT and MR imaging, expected appearance and complications of ACDF on postoperative imaging and imaging assessment of fusion. Optimization for optimizing metal induced artifacts. CONCLUSION Currently, ACDF is the most commonly performed surgical procedure for degenerative cervical spine disease. Interbody fusion is performed with bone grafts or interbody spacers, and may be supplemented with anterior cervical plating. Compressive pathologies at the vertebral body level may be addressed by simultaneous corpectomy. Postoperatively, imaging plays an integral role in routine screening of asymptomatic individuals, fusion assessment and evaluation of complications.
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Affiliation(s)
- Kimia Khalatbari Kani
- Department of Radiology, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Felix S Chew
- Department of Radiology, University of Washington, 4245 Roosevelt Way NE, Box 354755, Seattle, WA, 98105, USA
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Kang DG, Wagner SC, Tracey RW, Cody JP, Gaume RE, Lehman RA. Biomechanical Stability of a Stand-Alone Interbody Spacer in Two-Level and Hybrid Cervical Fusion Constructs. Global Spine J 2017; 7:681-688. [PMID: 28989848 PMCID: PMC5624375 DOI: 10.1177/2192568217700105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
STUDY DESIGN In vitro human cadaveric biomechanical analysis. OBJECTIVE To evaluate the segmental stability of a stand-alone spacer (SAS) device compared with the traditional anterior cervical plate (ACP) construct in the setting of a 2-level cervical fusion construct or as a hybrid construct adjacent to a previous 1-level ACP construct. METHODS Twelve human cadaveric cervical spines (C2-T1) were nondestructively tested with a custom 6-degree-of-freedom spine simulator under axial rotation (AR), flexion-extension (FE), and lateral bending (LB) at 1.5 N m loads. After intact analysis, each specimen underwent instrumentation and testing in the following 3 configurations, with each specimen randomized to the order of construct: (A) C5-7 SAS; (B) C5-6 ACP, and C6-7 SAS (hybrid); (C) C5-7 ACP. Full range of motion (ROM) data at C5-C7 was obtained and analyzed by each loading modality utilizing mean comparisons with repeated measures analysis of variance with Sidak correction for multiple comparisons. RESULTS Compared with the intact specimen, all tested constructs had significantly increased segmental stability at C5-C7 in AR and FE ROM, with no difference in LB ROM. At C5-C6, all test constructs again had increased segmental stability in FE ROM compared with intact (10.9° ± 4.4° Intact vs SAS 6.6° ± 3.2°, P < .001; vs.Hybrid 2.9° ± 2.0°, P = .005; vs ACP 2.1° ± 1.4°, P < .001), but had no difference in AR and LB ROM. Analysis of C6-C7 ROM demonstrated all test groups had significantly greater segmental stability in FE ROM compared with intact (9.6° ± 2.7° Intact vs SAS 5.0° ± 3.0°, P = .018; vs Hybrid 5.0° ± 2.7°, P = .018; vs ACP 4.4° ± 5.2°, P = .005). Only the hybrid and 2-level ACP constructs had increased stability at C6-C7 in AR ROM compared with intact, with no difference for all test groups in LB ROM. Comparison between test constructs demonstrated no difference in C5-C7 and C6-C7 segmental stability in all planes of motion. However, at C5-C6 comparison between test constructs found the 2-level SAS had significantly less segmental stability compared to the hybrid (6.6° ± 3.2° vs 2.9° ± 2.0°, P = .025) and ACP (6.6° ± 3.2° vs 2.1° ± 1.4°, P = .004). CONCLUSIONS Our study found the currently tested SAS device may be a reasonable option as part of a 2-level hybrid construct, when used below an adjacent 1-level ACP, but should be used with careful consideration as a 2-level SAS construct. Consequences of decreased segmental stability in FE are unknown; however, optimal immediate fixation stability is an important surgical principle to avoid loss of fixation, segmental kyphosis, interbody graft subsidence, and pseudarthrosis.
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Affiliation(s)
- Daniel G. Kang
- Madigan Army Medical Center, Tacoma, WA, USA,Daniel G. Kang, Department of Orthopedic Surgery, Madigan Army Medical Center, 9040 Jackson Avenue, Tacoma, WA 98431, USA.
| | - Scott C. Wagner
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | - John P. Cody
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Rachel E. Gaume
- Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Ronald A. Lehman
- The Spine Hospital, Columbia University Medical Center–New York Presbyterian, New York, NY, USA
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Overley SC, Merrill RK, Leven DM, Meaike JJ, Kumar A, Qureshi SA. A Matched Cohort Analysis Comparing Stand-Alone Cages and Anterior Cervical Plates Used for Anterior Cervical Discectomy and Fusion. Global Spine J 2017; 7:394-399. [PMID: 28811982 PMCID: PMC5544154 DOI: 10.1177/2192568217699211] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To compare perioperative characteristics of stand-alone cages and anterior cervical plates used for anterior cervical discectomy and fusion (ACDF). METHODS We reviewed 40 adult patients who received a stand-alone cage for elective ACDF and matched them with 40 patients who received an anterior cervical plate. We statistically compared operative time, length of stay, proportion of ambulatory cases, overall complications necessitating a trip to the ED, readmission, or reoperation related to index procedure. RESULTS There were 21 women and 19 men in the plate cohort with average ages of 53 years ± 12 and 20 women and 20 men in the stand-alone group with an average age of 52 years ± 11. With no statistical difference in total number, the plate group experienced 4 short-term (within 90 days of discharge) complications, including 3 patients who visited the emergency department for dysphagia and 1 who visited the emergency department for severe back pain, while the stand-alone group experienced 0 complications. There was no significant difference in operative time between the stand-alone group (75.35 min) and the plate group (81.35 min; P = .37). There was a significant difference between the proportion of ambulatory cases in the stand-alone group (25) and the plate group (6; P < .0001). CONCLUSION Our results demonstrate that stand-alone cages have fewer complications compared to anterior plating, with a lower trend of incidence of postoperative dysphagia. Stand-alone cages may offer the advantage of sending patients home ambulatory after ACDF surgery.
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Affiliation(s)
| | | | - Dante M. Leven
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Abhishek Kumar
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sheeraz A. Qureshi
- Icahn School of Medicine at Mount Sinai, New York, NY, USA,Sheeraz A. Qureshi, 5 East 98th St, 4th Floor, New York, NY 10029, USA.
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Bucci MN, Oh D, Cowan RS, Davis RJ, Jackson RJ, Tyndall DS, Nehls D. The ROI-C zero-profile anchored spacer for anterior cervical discectomy and fusion: biomechanical profile and clinical outcomes. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2017; 10:61-69. [PMID: 28458586 PMCID: PMC5403002 DOI: 10.2147/mder.s127133] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Anterior cervical discectomy and fusion (ACDF) has been the gold standard for treating cervical degenerative disc disease (cDDD). The use of anterior plates in ACDF poses an increased risk of complications such as screw or plate dislodgement, soft tissue injury, esophagus perforation, and dysphagia. The ROI-C™ implant system consists of a zero-profile interbody fusion cage with self-locking plates designed for stand-alone fusion without external plates or screws. Objective The purpose of this report is to describe the ROI-C™ implant system with VerteBRIDGE™ anchor plates, including indications for use, surgical technique, preclinical testing, and clinical study results. The objectives of the clinical study were to assess fusion status, incidence of dysphagia and other device-related complications, and patient reported outcomes. Methods This was a retrospective, multicenter cohort study of 110 patients who underwent ACDF with ROI-C at seven study centers. Patient charts and radiographs were reviewed for any complications or device malfunction. The final follow-up was conducted prospectively and included collection of neck disability index, and visual analog scale (VAS) neck and arm pain scores. Results The mean operation time was 73 minutes, and mean blood loss was 25 mL (range 0–75 mL). Mean follow-up was 20.7 months (range 9.5–42.2). Dysphagia was reported in two patients (1.8%), and 99.1% of patients achieved fusion. One patient had radiographically confirmed pseudarthrosis at 12 months that was asymptomatic and did not require surgery. One patient had subsequent surgery owing to adjacent level degeneration. The mean neck disability index, VAS neck pain, and VAS right and left arm pain scores at final follow-up were 19, 26.5, 12.5, and 15.3, respectively. Conclusion The ROI-C interbody cage with VerteBRIDGE anchor plates achieved a high rate of fusion, with a low incidence of dysphagia. These patients had similar or better outcomes compared to ACDF with anterior plating reported in peer-reviewed literature.
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Affiliation(s)
- Michael N Bucci
- Piedmont Spine and Neurosurgical Group, PA, Greenville, SC, USA
| | - Dennis Oh
- Baystate Medical Center, Springfield, MA, USA
| | - R Scott Cowan
- New England Orthopedic Surgeons, Inc., Springfield, MA, USA
| | | | | | | | - Daniel Nehls
- Franciscan Neurosurgery Associates at St. Joseph Medical Center, Tacoma, WA, USA
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Xiao S, Liang Z, Wei W, Ning J. Zero-profile anchored cage reduces risk of postoperative dysphagia compared with cage with plate fixation after anterior cervical discectomy and fusion. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:975-984. [PMID: 28004243 DOI: 10.1007/s00586-016-4914-5] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 12/04/2016] [Indexed: 12/27/2022]
Abstract
PURPOSE To compare the rate of postoperative dysphagia between zero-profile anchored cage fixation (ZPC group) and cage with plate fixation (CP group) after anterior cervical discectomy and fusion (ACDF). METHODS A meta-analysis of cohort studies between zero-profile anchored cage and conventional cage with plate fixation after ACDF for the treatment of cervical diseases from 2008 to May 2016. An extensive search of studies was performed in PubMed, Medline, Embase, Cochrane library and Google Scholar. Dysphagia rate was extracted. Data analysis was conducted with RevMan 5.2. RESULTS Sixteen trials involving 1066 patients were included in this meta-analysis. The results suggested that the ZPC group were associated with lower incidences of dysphagia than the CP group at postoperative immediately, 2 weeks, 2, 3, 6 and 12 months. In subgroup analysis, although significant differences were only found in the mild dysphagia at 3 and 6 months postoperatively and in the moderate dysphagia at 2 weeks after surgery; the ZPC group had a lower rate of postoperative dysphagia than the CCP group in short, medium and long term follow-up periods. CONCLUSIONS Zero-profile anchored cage had a lower risk of postoperative dysphagia than cage with plate.
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Affiliation(s)
- ShanWen Xiao
- Department of Spine and Orthopaedic Surgery, Red Cross Hospital of Guangxi Wuzhou, Xin Xing Road 1. #3-1, Wuzhou, 543000, China
| | - ZhuDe Liang
- Department of Spine and Orthopaedic Surgery, Red Cross Hospital of Guangxi Wuzhou, Xin Xing Road 1. #3-1, Wuzhou, 543000, China
| | - Wu Wei
- Department of Spine and Orthopaedic Surgery, Red Cross Hospital of Guangxi Wuzhou, Xin Xing Road 1. #3-1, Wuzhou, 543000, China
| | - JinPei Ning
- Department of Spine and Orthopaedic Surgery, Red Cross Hospital of Guangxi Wuzhou, Xin Xing Road 1. #3-1, Wuzhou, 543000, China.
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Shi S, Li XF, Zhao QT, Yang LL, Liu ZD, Yuan W. Risk Factors for Dysphagia After Single-Level Anterior Cervical Decompression with Arthroplasty or Fusion: A Prospective Study Comparing 2 Zero-Profile Implants. World Neurosurg 2016; 95:148-155. [DOI: 10.1016/j.wneu.2016.07.100] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 07/25/2016] [Accepted: 07/27/2016] [Indexed: 12/15/2022]
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Gerszten PC, Paschel E, Mashaly H, Sabry H, Jalalod'din H, Saoud K. Outcomes Evaluation of Zero-Profile Devices Compared to Stand-Alone PEEK Cages for the Treatment of Three- and Four-Level Cervical Disc Disease. Cureus 2016; 8:e775. [PMID: 27738574 PMCID: PMC5059158 DOI: 10.7759/cureus.775] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Anterior cervical discectomy and fusion (ACDF) is a well-accepted treatment option for patients with cervical spine disease. Three- and four-level discectomies are known to be associated with a higher complication rate and lower fusion rate than single-level surgery. This study was performed to evaluate and compare zero-profile fixation and stand-alone PEEK cages for three- and four-level ACDF. Methods: Two cohorts of patients who underwent ACDF for the treatment of three- and four-level disease were compared. Thirty-three patients underwent implantation of zero-profile devices that included titanium screw fixation (Group A). Thirty-five patients underwent implantation of stand-alone PEEK cages without any form of screw fixation (Group B). Results: In Group A, twenty-seven patients underwent a three-level and six patients a four-level ACDF, with a total of 105 levels. In Group B, thirty patients underwent a three-level and five patients underwent a four-level ACDF, with a total number of 110 levels. In Group A, the mean preoperative visual analog scale score (VAS) for arm pain was 6.4 (range 3-8), and the mean postoperative VAS for arm pain decreased to 2.5 (range 1-7). In group B, the mean preoperative VAS of arm pain was 7.1 (range 3-10), and the mean postoperative VAS of arm pain decreased to 2 (range 0-4). In Group A, four patients (12%) developed dysphagia, and in Group B, three patients (9%) developed dysphagia. Conclusions: This study found zero-profile instrumentation and PEEK cages to be both safe and effective for patients who underwent three- and four-level ACDF, comparable to reported series using plate devices. Rates of dysphagia for the cohort were much lower than reports using plate devices. Zero-profile segmental fixation devices and PEEK cages may be considered as viable alternatives over plate fixation for patients requiring multi-level anterior cervical fusion surgery.
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Affiliation(s)
- Peter C Gerszten
- Department of Neurological Surgery, University of Pittsburgh Medical Center
| | - Erin Paschel
- Department of Neurological Surgery, University of Pittsburgh Medical Center
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Mackiewicz A, Banach M, Denisiewicz A, Bedzinski R. Comparative studies of cervical spine anterior stabilization systems--Finite element analysis. Clin Biomech (Bristol, Avon) 2016; 32:72-9. [PMID: 26851563 DOI: 10.1016/j.clinbiomech.2015.11.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 11/23/2015] [Accepted: 11/25/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The object of the study was to assess the impact of one-level stabilization of the cervical spine for both anterior static and dynamic plates. Segments C2-C6 of the cervical spine, were investigated, from which was determined the stress and strain fields in the region of implantation and adjacent motion segments. The purpose was the comparison of changes that affect the individual stabilizers. METHODS For testing we used finite element analysis. The cervical spine model takes into account local spondylodesis. The study includes both an intact anatomical model and a model with implant stabilization. FINDINGS The analysis covered the model loaded with a moment of force for 1 Nm in the sagittal plane during movement. We compared both the modeled response of the whole fragment C2-C6 and the response of individual motion segments. The largest limitation of range of motion occurred after implantation with static plates. The study also showed that the introduction of the one-level stabilization resulted in an increase in stress in intervertebral disc endplates of adjacent segments. INTERPRETATION The results indicate that the increase in stress caused by stiffening may result in disorders in remodeling of bone structures. The use of dynamic plates showed improved continuity strains in the tested spine, thereby causing remodeling most similar to the physiological state and reducing the stresses in adjacent segments.
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Affiliation(s)
- A Mackiewicz
- University of Zielona Góra, Zielona Góra, Poland.
| | - M Banach
- St. Raphael Hospital in Krakow, Krakow, Poland.
| | | | - R Bedzinski
- University of Zielona Góra, Zielona Góra, Poland.
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Mattei TA, Teles AR, Dinh DH. Vertebral body fracture after anterior cervical discectomy and fusion with zero-profile anchored cages in adjacent levels: a cautionary tale. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 29:943-952. [PMID: 26733015 DOI: 10.1007/s00586-015-4358-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/03/2015] [Accepted: 12/03/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND CONTEXT Zero-profile (also called self-locking, anchored or stand-alone cages) have been recently proposed as an interesting alternative for anterior cervical discectomy and fusion (ACDF), as they are supposed to reduce the rates of post-operative cage extrusion without necessarily incurring in the additional surgical time and increased rates of dysphagia associated with plating. Nevertheless, the exact indications of zero-profile anchored cages have not yet been established in the literature. PURPOSE To report the first case of a vertebral body fracture between the blades of zero-profile anchored cages after ACDFs in adjacent levels and to review the available literature on hardware-related complications after multi-level ACDFs with zero-profile anchored cages. STUDY DESIGN Case report and systematic literature review. METHODS The authors report the first case of a vertebral body fracture between the blades of zero-profile anchored cages after ACDFs in adjacent levels. The patient presented with refractory mechanical neck pain at the 1-month post-operative follow-up, ultimately requiring a posterior instrumented fusion. A comprehensive systematic literature review on the available data regarding the safety, complications as well as radiological and clinical outcomes of zero-profile anchored cages is also performed. RESULTS In the reported case, the use of zero-profile anchored cages in adjacent levels on the cervical spine led to a fracture of the vertebral body between the cages at the 1-month follow-up, with anterior avulsion of the part of the vertebral body where the blades from the two cages converged. According to the systematic literature review which included 409 patients from 10 different clinical series (with a total cumulative follow-up of approximately 535 patients-year), there were only two reported hardware-related complications after ACDF with zero-profile anchored cages, none of them involving fracture at the level of convergence of blades or screws. CONCLUSIONS Although hardware-related complications after the use of zero-profile anchored cages seem to be rare events, future biomechanical and clinical studies are warranted in order to evaluate the safety of employing such devices for the treatment of multilevel degenerative disc disease in the cervical spine.
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Affiliation(s)
- Tobias A Mattei
- Department of Neurosurgery, Brain and Spine Center/InvisionHealth, 400 International Drive, Buffalo, NY, 14221, USA.
| | - Alisson R Teles
- Neurosurgery Unit, Hospital São José-Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | - Dzung H Dinh
- Department of Neurosurgery, The University of Illinois at Peoria, Peoria, IL, USA
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Santoni B, Cabezas AF, Cook DJ, Yeager MS, Billys JB, Whiting B, Cheng BC. Comparison of Intervertebral ROM in Multi-Level Cadaveric Lumbar Spines Using Distinct Pure Moment Loading Approaches. Int J Spine Surg 2015; 9:32. [PMID: 26273550 DOI: 10.14444/2032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Pure-moment loading is the test method of choice for spinal implant evaluation. However, the apparatuses and boundary conditions employed by laboratories in performing spine flexibility testing vary. The purpose of this study was to quantify the differences, if they exist, in intervertebral range of motion (ROM) resulting from different pure-moment loading apparatuses used in two laboratories. METHODS Twenty-four (laboratory A) and forty-two (laboratory B) intact L1-S1 specimens were loaded using pure moments (±7.5 Nm) in flexion-extension (FE), lateral bending (LB) and axial torsion (AT). At laboratory A, pure moments were applied using a system of cables, pulleys and suspended weights in 1.5 Nm increments. At laboratory B, specimens were loaded in a pneumatic biaxial test frame mounted with counteracting stepper-motor-driven biaxial gimbals. ROM was obtained in both labs using identical optoelectronic systems and compared. RESULTS In FE, total L1-L5 ROM was similar, on average, between the two laboratories (lab A: 37.4° ± 9.1°; lab B: 35.0° ± 8.9°, p=0.289). Larger apparent differences, on average, were noted between labs in AT (lab A: 19.4° ± 7.3°; lab B: 15.7° ± 7.1°, p=0.074), and this finding was significant for combined right and left LB (lab A: 45.5° ± 11.4°; lab B: 35.3° ± 8.5°, p < 0.001). CONCLUSIONS To our knowledge, this is the first study comparing ROM of multi-segment lumbar spines between laboratories utilizing different apparatuses. The results of this study show that intervertebral ROM in multi-segment lumbar spine constructs are markedly similar in FE loading. Differences in boundary conditions are likely the source of small and sometimes statistically significant differences between the two techniques in LB and AT ROM. The relative merits of each testing strategy with regard to the physiologic conditions that are to be simulated should be considered in the design of a study including LB and AT modes of loading. An understanding of these differences also serves as important information when comparing study results across different laboratories.
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Affiliation(s)
| | | | - Daniel J Cook
- Allegheny Health Network, Department of Neurosurgery, Pittsburgh, PA
| | - Matthew S Yeager
- Allegheny Health Network, Department of Neurosurgery, Pittsburgh, PA
| | - James B Billys
- Allegheny Health Network, Department of Neurosurgery, Pittsburgh, PA
| | - Benjamin Whiting
- Allegheny Health Network, Department of Neurosurgery, Pittsburgh, PA
| | - Boyle C Cheng
- Allegheny Health Network, Department of Neurosurgery, Pittsburgh, PA
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Lane PD, Cox JL, Gaskins RB, Santoni BG, Billys JB, Castellvi AE. Early Radiographic and Clinical Outcomes Study Evaluating an Integrated Screw and Interbody Spacer for One- and Two-Level ACDF. Int J Spine Surg 2015; 9:39. [PMID: 26273557 DOI: 10.14444/2039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Multiple techniques and implants can be used in ACDF, the newest of which are integrated cage and screw constructs. These devices may be beneficial over anterior plate constructs due to a negligible anterior profile that may reduce dysphagia. The goal of this study is to review the early radiographical and clinical results associated with a low profile integrated intervertebral cage in one- and two-level anterior column fusions. METHODS Fusion rates, incidence of hardware failure and deformity correction were assessed through 1 year. Patientreported scores, including VAS for neck pain, and improvements in axial neck pain and neurologic deficit from the preoperative baseline were quantified at 3, 6 and 12 months post-operatively. The incidence of dysphagia was recorded. RESULTS Lordosis and disc space height at the operated levels increased an average of 4.5° and 3.3mm after device placement (p<0.001). Sagittal plane correction was maintained at 1 year. VAS improved from an average of 5.1 preoperatively to 3.1 immediately postoperatively and was maintained at 12 months. At 3 months, patient-reported improvements in axial neck pain and neurologic deficit were 85% and 93%, respectively. Reported improvements were sustained for both parameters at 12 months (77% and 86%, respectively). Fusion was noted in 93% of the operated levels. There were two documented cases of dysphagia that lasted more than 5 weeks, both following two level ACDFs with the test device (3.5% rate of chronic dysphagia). CONCLUSIONS The low profile integrated device improved lordosis at the operated level that was maintained at 1 year. Fusion rates with the new device are consistent with ACDF using anterior plating. In combination with improvements in pain and a minimal rate of dysphagia, study findings support the use of integrated interbody spacers for use in one- and two-level ACDF procedures. LEVEL OF EVIDENCE Level IV, Case Series.
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Affiliation(s)
| | - Jacob L Cox
- University of South Florida, Department of Orthopaedics and Sports Medicine, Tampa, FL
| | - Roger B Gaskins
- University of South Florida, Department of Orthopaedics and Sports Medicine, Tampa, FL
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Emstad E, Del Monaco DC, Fielding LC, Block JE. The VariLift(®) Interbody Fusion System: expandable, standalone interbody fusion. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2015; 8:219-30. [PMID: 26060414 PMCID: PMC4454196 DOI: 10.2147/mder.s84715] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Intervertebral fusion cages have been in clinical use since the 1990s. Cages offer the benefits of bone graft containment, restored intervertebral and foraminal height, and a more repeatable, stable procedure compared to interbody fusion with graft material alone. Due to concerns regarding postoperative stability, loss of lordosis, and subsidence or migration of the implant, interbody cages are commonly used with supplemental fixation such as pedicle screw systems or anterior plates. While providing additional stability, supplemental fixation techniques increase operative time, exposure, cost, and morbidity. The VariLift(®) Interbody Fusion System (VariLift(®) system) has been developed as a standalone solution to provide the benefits of intervertebral fusion cages without the requirement of supplemental fixation. The VariLift(®) system, FDA-cleared for standalone use in both the cervical and lumbar spine, is implanted in a minimal profile and then expanded in situ to provide segmental stability, restored lordosis, and a large graft chamber. Preclinical testing and analyses have found that the VariLift(®) System is durable, and reduces stresses that may contribute to subsidence and migration of other standalone interbody cages. Fifteen years of clinical development with the VariLift(®) system have demonstrated positive clinical outcomes, continued patient maintenance of segmental stability and lordosis, and no evidence of implant migration. The purpose of this report is to describe the VariLift(®) system, including implant characteristics, principles of operation, indications for use, patient selection criteria, surgical technique, postoperative care, preclinical testing, and clinical experience. The VariLift(®) System represents an improved surgical option for a stable interbody fusion without requiring supplemental fixation.
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A zero-profile anchored spacer in multilevel cervical anterior interbody fusion: biomechanical comparison to established fixation techniques. Spine (Phila Pa 1976) 2015; 40:E375-80. [PMID: 25584947 DOI: 10.1097/brs.0000000000000768] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN In vitro biomechanical analysis of different multilevel cervical fixation techniques. OBJECTIVE To compare the multilevel stability of a cervical anchored spacer (AS) with established fixation techniques. SUMMARY OF BACKGROUND DATA To avoid plate-related complications, for example, dysphagia zero-profile AS has been developed. The use of these new zero-profile implants for treatment of cervical degenerative disc disease is widely accepted after encouraging biomechanical results for single-level instrumentation. However, there is only little knowledge about the biomechanical stability of these zero-profile devices in multilevel instrumentations. METHODS Eight fresh-frozen human cadaveric cervical spines (C3-C7) were nondestructively tested in a biomechanical 3-dimensional spine test setup. Segmental range of motion (ROM) under torsional load of 1.5 N·m was measured optoelectronically. Intact spine baseline measurement specimens were tested with 2- and 3-level instrumentation including (1) stand-alone PEEK-cage; (2) PEEK-cage plus locking plate; and (3) AS. Repeated-measures analyses of variance were used for statistical analysis. RESULTS Comparison of baseline ROM and stand-alone PEEK-cage instrumentation showed a significant lower segmental ROM only for 2-level instrumentations. Cage plus plate and AS were able to reduce segmental ROM significantly (P < 0.05) in 2- and 3-level instrumentations. Comparing cage plus plate and AS, a significant lower ROM was detected for flexion/extension in 2- and 3-level instrumentation and for lateral bending in 2-level instrumentation using cage plus plate. CONCLUSION Segmental stability decreases with the number of instrumented segments regardless of the used implant. Comparing the different fixation techniques biomechanically, the locking plate and cage construct was stiffer in all test modes than the anchored devices in multilevel constructs. However, it remains unclear what the clinical significance may be. LEVEL OF EVIDENCE N/A.
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Nayak AN, Stein MI, James CR, Gaskins RB, Cabezas AF, Adu-Lartey M, Castellvi AE, Santoni BG. Biomechanical analysis of an interbody cage with three integrated cancellous lag screws in a two-level cervical spine fusion construct: an in vitro study. Spine J 2014; 14:3002-10. [PMID: 24948039 DOI: 10.1016/j.spinee.2014.06.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 04/15/2014] [Accepted: 06/09/2014] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Despite an increase in the clinical use of no-profile anchored interbody cages (AIC) for anterior cervical discectomy and fusion (ACDF) procedures, there is little published biomechanical data describing its stabilizing effect relative to the traditional anterior plating technique over two contiguous levels. PURPOSE To biomechanically compare the acute stability conferred by a stand-alone interbody fusion device with three integrated fixation screws ("anchored cage") with a traditional six-hole rigid anterior plate in a two contiguous levels (C4-C5+C5-C6) fusion construct. We hypothesized that the anchored cage would confer comparable segmental rigidity to the cage and anterior plate construct. STUDY DESIGN A biomechanical laboratory study using cadaveric human cervical spines. METHODS Seven (n=7) cadaveric human cervical spines (C3-C7) were subjected to quasistatic, pure-moment loading (±1.5 Nm) in flexion-extension (flex/ext), right/left lateral bending (RB/LB), and right/left axial rotation (RR/LR) for the following test conditions: intact; after discectomy and insertion of the AIC at C4-C5 and C5-C6 with anchoring screws engaged; after the removal of the integrated anchoring screws and instrumentation of an anterior locking plate (ALP) over both levels; and cage-only (CO) configuration with screws and anterior plate removed. Intervertebral range of motion (ROM) at the instrumented levels was the primary biomechanical outcome. RESULTS Flex/ext, RB/LB, and RR/LR ROMs were significantly reduced (p<.001) over both levels by AIC and ALP constructs relative to the CO construct. Significant reduction in flex/ext motion was achieved with the ALP (6.8±3.7) relative to the AIC (10.2°±4.6°) (p=.041) construct. No significant differences were seen in ROM reductions over the two levels between the AIC and APL groups in lateral bending or axial rotation (p>.826). CONCLUSIONS The anchored cage fusion construct conferred similar acute biomechanical stability in lateral bending and axial rotation ROMs relative to rigid anterior plating. We identified a statistically significant reduction (Δ=3.4°, combined over two levels) in sagittal plane ROM conferred by the ALP relative to the AIC construct. Our biomechanical findings may support the clinical use of no-profile integrated interbody devices over two contiguous levels in ACDF.
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Affiliation(s)
- Aniruddh N Nayak
- Phillip Spiegel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research & Education, 13020 N. Telecom Parkway, Tampa, FL 33637, USA
| | - Matthew I Stein
- Department of Orthopaedic & Sports Medicine, University of South Florida, 3220 USF Laurel Drive, MDC106, Tampa, FL 33612, USA
| | - Chris R James
- Phillip Spiegel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research & Education, 13020 N. Telecom Parkway, Tampa, FL 33637, USA
| | - Roger B Gaskins
- Department of Orthopaedic & Sports Medicine, University of South Florida, 3220 USF Laurel Drive, MDC106, Tampa, FL 33612, USA
| | - Andres F Cabezas
- Phillip Spiegel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research & Education, 13020 N. Telecom Parkway, Tampa, FL 33637, USA
| | - Maxwell Adu-Lartey
- Center for Spinal Disorders, Florida Orthopaedic Institute, 13020 N. Telecom Parkway, Tampa, FL 33637, USA
| | - Antonio E Castellvi
- Center for Spinal Disorders, Florida Orthopaedic Institute, 13020 N. Telecom Parkway, Tampa, FL 33637, USA
| | - Brandon G Santoni
- Phillip Spiegel Orthopaedic Research Laboratory, Foundation for Orthopaedic Research & Education, 13020 N. Telecom Parkway, Tampa, FL 33637, USA; Department of Orthopaedic & Sports Medicine, University of South Florida, 3220 USF Laurel Drive, MDC106, Tampa, FL 33612, USA.
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